Infection after penetrating brain injury—An Eastern Association for the Surgery of Trauma multicenter study oral presentation at the 32nd annual meeting of the Eastern Association for the Surgery of Trauma, January 15–19, 2019, in Austin, Texas

Document Type

Presentation

Publication Date

7-2019

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Abstract

2019 EAST PODIUM PAPER

Infection after penetrating brain injury—An Eastern Association for the Surgery of Trauma multicenter study oral presentation at the 32nd annual meeting of the Eastern Association for the Surgery of Trauma, January 15–19, 2019, in Austin, Texas

Harmon, Laura A. MD; Haase, Daniel J. MD; Kufera, Joseph A. MA; Adnan, Sakib BS; Cabral, Donna BNS; Lottenberg, Lawrence MD; Cunningham, Kyle W. MD, MPH; Bonne, Stephanie MD; Burgess, Jessica MD; Etheridge, James MD; Rehbein, Jennifer L. MD; Semon, Gregory DO; Noorbakhsh, Matthew R. MD; Cragun, Benjamin N. MD; Agrawal, Vaidehi PhD; Truitt, Michael MD; Marcotte, Joseph MD; Goldenberg, Anna DO; Behbahaninia, Milad MD; Keric, Natasha MD; Hammer, Peter M. MD; Nahmias, Jeffry MD; Grigorian, Areg MD; Turay, Dave MD; Chakravarthy, Vikram MD; Lalchandani, Priti MD; Kim, Dennis MD; Chapin, Trinette; Dunn, Julie MD; Portillo, Victor MD; Schroeppel, Thomas MD, MS; Stein, Deborah M. MD, MPH Author Information Journal of Trauma and Acute Care Surgery 87(1):p 61-67, July 2019. | DOI: 10.1097/TA.0000000000002327

Abstract

BACKGROUND

Fatality rates following penetrating traumatic brain injury (pTBI) are extremely high and survivors are often left with significant disability. Infection following pTBI is associated with worse morbidity. The modern rates of central nervous system infections (INF) in civilian survivors are unknown. This study sought to determine the rate of and risk factors for INF following pTBI and to determine the impact of antibiotic prophylaxis.

METHODS

Seventeen institutions submitted adult patients with pTBI and survival of more than 72 hours from 2006 to 2016. Patients were stratified by the presence or absence of infection and the use or omission of prophylactic antibiotics. Study was powered at 85% to detect a difference in infection rate of 5%. Primary endpoint was the impact of prophylactic antibiotics on INF. Mantel-Haenszel χ2 and Wilcoxon's rank-sum tests were used to compare categorical and nonparametric variables. Significance greater than p = 0.2 was included in a logistic regression adjusted for center.

RESULTS

Seven hundred sixty-three patients with pTBI were identified over 11 years. 7% (n = 51) of patients developed an INF. Sixty-six percent of INF patients received prophylactic antibiotics. Sixty-two percent of all patients received one dose or greater of prophylactic antibiotics and 50% of patients received extended antibiotics. Degree of dural penetration did not appear to impact the incidence of INF (p = 0.8) nor did trajectory through the oropharynx (p = 0.18). Controlling for other variables, there was no statistically significant difference in INF with the use of prophylactic antibiotics (p = 0.5). Infection was higher in patients with intracerebral pressure monitors (4% vs. 12%; p = <0.001) and in patients with surgical intervention (10% vs. 3%; p < 0.001).

CONCLUSION

There is no reduction in INF with prophylactic antibiotics in pTBI. Surgical intervention and invasive intracerebral pressure monitoring appear to be risk factors for INF regardless of prophylactic use.

LEVEL OF EVIDENCE

Therapeutic, level IV.

DOI

10.1097/TA.0000000000002327

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